Early in-hospital deaths following pediatric heart continue to be a significant problem. Multiple studies have defined potential risk factors for early death but a validated risk predication model for in-hospital mortality does not exist. This study aimed to develop and validate such a model to assist in predicting in-hospital mortality following pediatric heart transplantation. This study utilized the Organ Procurement and Transplant Network (OPTN) database for all children <18 years who underwent a heart transplant, between 1989-2008. The predictive model developed included 4 specific categories: hemodynamic support, cardiac diagnosis, renal dysfunction and total bilirubin. The overall risk for in-hospital mortality was 7% , with the predicted risk ranging from 1% to 65% based on the above 4 patient factors. This model may be useful for predicting in-hospital mortality at an institutional level and may serve as a guide for decision making around listing and institution of mechanical support.